What doctors wish patients knew about decision fatigue

Making decisions day in and day out—whether they are as easy picking a route home from work or as difficult as navigating a once-in-a-lifetime pandemic—can be exhausting and cause people to feel overwhelmed, anxious or stressed. 

This is known as decision fatigue, which is a state of mental overload that can impede a person’s ability to continue making decisions. You have probably experienced decision fatigue during the pandemic because it has added new layers of complexity to the daily choices we are confronted with.

The AMA’s What Doctors Wish Patients Knew™ series provides physicians with a platform to share what they want patients to understand about today’s health care headlines, especially throughout the COVID-19 pandemic.

For this installment, AMA member Lisa MacLean, MD, took the time to discuss what patients need to know about decision fatigue. Dr. MacLean is a psychiatrist and chief wellness officer at Henry Ford Health System, an AMA Health System Program member.

Decision fatigue is “the idea that after making many decisions, your ability to make more and more decisions over the course of a day becomes worse,” said Dr. MacLean, a psychiatrist. “The more decisions you have to make, the more fatigue you develop and the more difficult it can become.”

“Every day, just in our personal lives, we are making a ton of decisions. And a lot of these decisions you are not consciously making,” she said. For example, “you open the refrigerator door and sometimes the only thing that’s in there is bagels and that’s a pretty easy decision.

“But if there’s a lot of different things in terms of ... what do I eat, what do I wear, what do I do with my day especially on a day off, that can create stress,” Dr. MacLean added, noting that “by the time the average person goes to bed, they’ve made over 35,000 decisions and all of those decisions take time and energy, and certainly can deplete us.”

Discover what doctors wish patients knew about pandemic fatigue. 

While decision fatigue is not a new phenomenon, the COVID-19 pandemic has caused life to become “more complicated and we have to make more and more decisions in an ever-increasing complex health care environment,” said Dr. MacLean.

“The addition of the pandemic has only made things worse and added to moral distress, especially when caring for COVID patients during the peak of the pandemic,” she said, adding that decisions that stem from the pandemic extend to wearing a mask, getting vaccinated against COVID-19 and whether it is safe to travel.

“All of this adds to the burden of decision fatigue,” said Dr. MacLean.

Read about what doctors wish patients knew about post-COVID anxiety.

For physicians, “we have our decisions at work and our decisions at home,” said Dr. MacLean. “Then we have this pandemic and the burden of decision-making intensified even more.”

As doctors “we had to make decisions we had never had to make before, and we’ve had to manage the anxiety of our patients,” she said. For patients, new questions about emerged about when to wear a mask and how to be assured about the safety and effectiveness of newly developed COVID-19 vaccines.

“A person with decision fatigue may feel tired, have brain fog or experience other signs and symptoms of physical or mental fatigue,” Dr. MacLean explained. “The phenomenon is cumulative so that as the person makes more decisions, they may feel worse or more drained as the day progresses. 

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“The more choices you have to make, the more it can wear on your brain, and it may cause your brain to look for short cuts,” she added, noting that “there are four main symptoms: procrastination, impulsivity, avoidance and indecision.”

“You are either putting the decision off until later, making a rash decision based on little evidence, avoiding the decision altogether or battling back and forth between various choices,” said Dr. MacLean. “The psychological effects of decision fatigue can vary, potentially leading to difficulty making the right decisions, impulse buying or other avoidance behaviors.

“If your brain is worn down, it may cause you to become more reckless with your decision making or not think things through,” she added. It can also “cause you to simply do nothing, which can cause even more problems.”

Additionally, “you might notice that you get angrier with colleagues and families, splurge on clothes, or impulsively buy more junk food,” Dr. MacLean noted.

Discover what doctors wish patients knew about coping with pandemic anger.

One way to overcome decision fatigue is to “make fewer decisions by streamlining your choices,” said Dr. MacLean. That means “avoid random decision-making by making lists. This way when you are at the grocery store, you don’t have to decide what to buy."

Another example is to “pick your clothes out the night before and automate your decisions by setting up automatic bill paying,” she said. “Even using GPS can help you to easily find your way by not overtaxing your brain.”

Additionally, “simplify your life by cutting out things that aren’t important,” Dr. MacLean suggested. “Having fewer tasks and activities will lead to fewer decisions, and help you to feel restored and have more control over your life.”

If you are experiencing decision fatigue, try to “delegate decisions. This means stop micromanaging and let others in your life make some decisions,” said Dr. MacLean. “There are times your co-workers can pick the lunch spot, your kids can choose the playlist, or your friends can pick the restaurant.”

“By delegating, you also empower people by showing them that you trust them,” she added. Additionally, “set deadlines to space out decisions such as creating micro-deadlines for bigger projects, so you aren’t forced to make too many big decisions at the end. This will allow you to use your best judgement.”

“Research shows that the best time to make decisions is in the morning,” said Dr. MacLean, emphasizing that “the morning is when we make the most accurate and thoughtful decisions, and we tend to be more cautious and meticulous.

“We hit a plateau in the afternoon and by evening our decisions may be more impulsive,” she added. “So, definitely don’t make big decisions when you’re tired or hungry.”

“Avoid rehashing decisions and stop second-guessing yourself,” said Dr. MacLean. “Just let go of that perfectionism—you’ve narrowed it down to those two or three things.

“Make the choice and be happy with the choice because we waste additional energy worrying about whether or not it was the right one,” she added. “Remember, you made the best decision in that moment with what you knew and don’t keep going back to it because that’s going to add to the fatigue.”

When someone can “develop daily routines that put less important tasks on autopilot, it can make a big difference,” said Dr. MacLean. For example, “set your wake-up time and stick to it.”

Additionally, “instead of debating about working out or not, make it part of your daily routine,” she said. “And if you like cereal, eat it every day to minimize decisions of what to eat for breakfast.

“Another idea is to have a handful of go-to outfits planned out to further minimize decisions made,” Dr. MacLean added. “The bottom line is, look at all the big and little decisions you make every day and think about how you can simplify your life.”

“By changing your habits and setting up the right routines, you can decrease anxiety and conserve your energy for the decisions that really matter,” she said.

While decision fatigue doesn’t warrant a trip to the doctor, “if you notice burnout symptoms like exhaustion, cynicism and low self-efficacy or are struggling with depression and anxiety, you can consider seeking help,” said Dr. MacLean. Decision fatigue “is a phenomenon that with other issues could make it worse.”

“We will always have to make decisions but maybe when life returns to a normal routine, the number of decisions we have to make will decrease,” she said.